National and State Estimates of COPD Morbidity and Mortality — United States, 2014-2015

Sullivan, Jamie; Pravosud, Vira; Mannino, David M.; Siegel, Keith; Choate, Radmila; Sullivan, Tracie

doi:10.15326/jcopdf.5.4.2018.0157

Cited by 78 publications

(81 citation statements)

References 3 publications

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“…In the USA, 12 million adults have been diagnosed with COPD, and similar numbers are thought to have the disease but remain undiagnosed [2]. COPD is responsible for over 140,000 deaths and over $50 billion in combined direct and indirect costs annually in the USA [1,3]. An observational study in the USA found that there were 10.3 million physician office visits, 1.5 million emergency department visits, and 699,000 hospital discharges for COPD in 2010 [4].…”

Section: Introductionmentioning

confidence: 99%

Current evidence for COPD management with dual long-acting muscarinic antagonist/long-acting β₂-agonist bronchodilators

Skolnik

Nguyen

Shrestha

et al. 2020

Postgraduate Medicine

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Long-acting inhaled bronchodilator medications are recommended as initial maintenance therapy for many patients with COPD. These medications include long-acting muscarinic antagonists (LAMA) and long-acting β 2-agonists (LABA). Combinations of long-acting bronchodilator agents (LAMA/LABA) and inhaled corticosteroids combined with LABA (ICS/LABA) are also used as initial or follow-up therapy in patients with more severe symptoms or at risk of COPD exacerbations. This review summarizes the position of LAMA/LABA combinations in treatment recommendations, and the evidence supporting their placement relative to LAMA monotherapy and ICS/LABA combination therapy, as well as differences within the LAMA/LABA class. Most studies show that LAMA/LABA treatment leads to greater improvements in lung function and symptoms than LAMA monotherapy or ICS/LABA treatment. There are fewer studies comparing the impact of different medication classes on patients' risk of exacerbations; however, the available evidence suggests that LAMA/LABA treatment and LAMA monotherapy lead to a similar reduction in exacerbation risk, while the effect of LAMA/LABA compared with ICS/LABA remains unclear. The incidence of adverse events is similar with LAMA/LABA and LAMA alone. There is a lower risk of pneumonia with LAMA/LABA compared with ICS/LABA. This evidence supports the use of LAMA/LABA combinations as an initial maintenance therapy option for symptomatic patients with low exacerbation risk and severe breathlessness or patients with severe symptoms who are at risk of exacerbations, and as follow-up treatment in patients with uncontrolled symptoms or exacerbations on bronchodilator monotherapy.

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Section: Introductionmentioning

confidence: 99%

Current evidence for COPD management with dual long-acting muscarinic antagonist/long-acting β₂-agonist bronchodilators

Skolnik

Nguyen

Shrestha

et al. 2020

Postgraduate Medicine

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“…Additionally, the age-adjusted prevalence of self-reported HTN among adults in Louisiana was 37.5% in 2015, whereas the national average was 29.8% 8 . Data from the Behavioral Risk Factor Surveillance System between 2014 and 2015 showed that the age-adjusted prevalence of self-reported, physician-diagnosed COPD among adults in Louisiana was about 7.1%; and, 45.3% of those patients listed asthma as a comorbidity 9 . Furthermore, Louisiana has the sixth-highest adult obesity rate in the nation at 36.2% (up from 22.6% in 2000 and 12.3% in 1990); and, while it is not always considered a chronic condition itself, obesity is associated with a high risk for other chronic illnesses like diabetes, HTN, and cardiovascular disease [10][11][12] .…”

Section: Chronic Disease Burdenmentioning

confidence: 99%

Evaluation of four disease management programs: evidence from blue cross blue shield of Louisiana

Liu

Yuan

Ouyang

et al. 2020

Journal of Medical Economics

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“…COPD is a common cause of significant mortality and morbidity in the United States and across the world. [1][2][3] It carries a large financial burden that is mostly attributed to the rate of exacerbations and hospital readmissions. In the United States alone, total medical costs are estimated at $73 billion annually.…”

Section: Introductionmentioning

confidence: 99%

COPD Overdiagnosis and Its Effect on 30-Day Hospital Readmission Rates

2020

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BACKGROUND: Although specific guidelines exist for diagnosing COPD on the basis of spirometry testing data (FEV 1 /FVC < 0.70 or above the lower limit of normal), the literature suggests that overdiagnosis is common. Whether overdiagnosis increases 30-d readmission rates has not yet been explored. The objective of this study was to determine the prevalence of COPD overdiagnosis and its effect on 30-d hospital readmission rates in our institution. METHODS: We retrospectively identified all subjects who were coded with a COPD hospital discharge in 2018 at Cleveland Clinic main campus and had spirometry data available, including FEV 1 and FVC. FEV 1 /FVC was calculated and compared with the predicted lower limit of normal values. Hospital discharge diagnosis and 30-d hospital readmission data were captured along with comorbidities and other demographics. RESULTS: In 2018, there were 424 hospital discharges with a COPD diagnosis with spirometry testing available. Of these subjects, 124 (29%) were overdiagnosed in the lower limit of normal group and 99 (23.3%) were in the 6 0.70 group. One hundred subjects (23.6%) had a 30-d hospital readmission. Of these subjects, 35 had FEV 1 /FVC that was greater than their predicted lower limit of normal on spirometry. Of the 324 subjects who were not readmitted within 30 d, 89 (27.5%) had FEV 1 /FVC greater than the lower limit of normal. If the 35 readmitted subjects had not been coded with COPD, the 30-d readmission rate would have decreased significantly from 23.6% to 16.7% (100 of 424 vs 65 of 389, P 5 .01). Even if all of the 124 subjects who had pulmonary function test data greater than the lower limit of normal had not been counted, the readmission rate would still have decreased from 23.6% to 21.7%, but this was not significant (from 100 of 424 to 65 of 300, P 5 .3). CONCLUSIONS: COPD was overdiagnosed in our cohort of subjects; this was true whether the FEV 1 /FVC < 0.70 standard or the lower limit of normal standard was used. Furthermore, this overdiagnosis artificially inflated the 30-d readmission rate. These results illustrate the caution providers should use when making a COPD diagnosis.

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National and State Estimates of COPD Morbidity and Mortality — United States, 2014-2015

Abstract: For personal use only. Permission required for all other uses.

Cited by 78 publications

References 3 publications

Current evidence for COPD management with dual long-acting muscarinic antagonist/long-acting β₂-agonist bronchodilators

Current evidence for COPD management with dual long-acting muscarinic antagonist/long-acting β₂-agonist bronchodilators

Evaluation of four disease management programs: evidence from blue cross blue shield of Louisiana

COPD Overdiagnosis and Its Effect on 30-Day Hospital Readmission Rates

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National and State Estimates of COPD Morbidity and Mortality — United States, 2014-2015

Abstract: For personal use only. Permission required for all other uses.

Cited by 78 publications

References 3 publications

Current evidence for COPD management with dual long-acting muscarinic antagonist/long-acting β2-agonist bronchodilators

Current evidence for COPD management with dual long-acting muscarinic antagonist/long-acting β2-agonist bronchodilators

Evaluation of four disease management programs: evidence from blue cross blue shield of Louisiana

COPD Overdiagnosis and Its Effect on 30-Day Hospital Readmission Rates

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Product

Resources

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Current evidence for COPD management with dual long-acting muscarinic antagonist/long-acting β₂-agonist bronchodilators

Current evidence for COPD management with dual long-acting muscarinic antagonist/long-acting β₂-agonist bronchodilators